Since the tragic school shooting in Newtown, Conn., mental health as been part of a nationwide
conversation about what to do about
gun violence. As the world’s largest
organization of behavioral health
practitioners and scientists, APA has
much to contribute to this discussion.

In recognition of APA’s expertise,

the White House invited Dr. Norman B. Anderson, our
chief executive officer, to a Jan. 9 meeting, where he stressed
five major points: 1. Improve and expand school violence
prevention efforts, including the formation of school threat
assessment teams; 2. make communities safer, including
instituting a public health campaign to encourage help-seeking for persons in distress; 3. enhance access to mental
and behavioral health and substance use services, including
making mandatory these services provided by psychologists;
4. increase federal funding for vital service and training
programs, including guaranteed funding for the Graduate
Psychology Education Program; and 5. enhance the knowledge
base for sound public policy on violence prevention, including
funding a research agenda.

A week later, as a result of this meeting and others, President
Obama presented four steps that he said could be taken
immediately: 1. close background check loopholes to keep
guns out of dangerous hands; 2. ban military-style assault
weapons and high capacity magazines; 3. make schools safer;
and 4. increase access to mental health services. As part of
the plan to make schools safer, the Obama administration is
advocating for $150 million to school districts to hire, among
others, school psychologists to help foster safer and more
nurturing school climates. As part of its plan to increase access
to mental health services, the administration is proposing to
fund the training of 5,000 more mental health professionals,
including psychologists, by providing stipends and tuition
reimbursement. Most relevant to current practitioners, the
administration is issuing final regulations governing group
health plans requiring that they cover mental health services
at parity with physical health plans. The Affordable Care Act
already requires all new small group and individual plans to
cover 10 essential health benefit categories, including mental
health and substance abuse services.

With 30,000 firearm-related homicides and suicides a
year, the president called gun violence a public health crisis.
But research into gun violence apparently has been barred
by Congress as a result of lobbying by the National Rifle
Association. The president has disputed that there is any real
prohibition and has directed the Centers for Disease Control
and Prevention to identify the most pressing research questions
and has called on Congress to provide $10 million so that CDC
can conduct that research.

APA is already ahead of the game. At Monitor press time,
APA’s Council of Representatives was considering the creation
of a task force to develop a policy on the prediction and
prevention of gun violence. In January, the Board of Directors,
acting on behalf of the council, allocated almost $35,000 to
fund a literature review and working group to evaluate and
revise as necessary two APA resolutions on violence in video
games and mass media.

There is the danger that tragic events will lead to quick
but faulty solutions with unintended consequences. One
example is the passage by the New York legislature of its Safe
Act. Among other provisions, the act requires mental health
professionals to report to the director of community services
who shall, in turn, report to the Division of Criminal Justices
Services when they determine that a patient is “likely to engage
in conduct that would result in serious harm to self or others.”
This means psychologists in these cases are mandated to breach
confidentiality. APA’s Code of Ethics requires practitioners to
disclose the limits of confidentiality. Knowing that the utterance
of violent urges may be disclosed to the state, the patient is
likely to avoid discussing these urges. And, if disclosed, the
patient may see this as a breach of trust and never return to
therapy (just like the patient in Tarasoff v. Board of Regents).
That the act holds mental health professionals immune from
civil or criminal liability for disclosures reasonably made under
the likelihood standard, will only increase the possibility of
disclosure. In fact, as I interpret the likelihood standard, it
would only require a 50 percent possibility that the patient is
dangerous. This in itself will lead to a great many false positives
and unwarranted breaches of confidentiality.

Fortunately, APA is more thoughtful than the New York
legislature. Its practice and research agenda will, it is hoped,
contribute to the national dialogue on gun violence in a
responsible and data-oriented way. n